The COVID-19 vaccination campaign in Bhutan: strategy and enablers

Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15, 2021. With support from India, the United States, Denmark, the People’s Republic of China, Croatia and other countries, Bhutan was able to conduct two rounds of nationwide vaccination campaign. While many countries struggle to overcome vaccine refusal or hesitancy due to complacency, a lack of trust, inconvenience and fear, escalated in some countries by anti-vaccine groups, Bhutan managed to inoculate more than 95% of its eligible populations in two rounds of vaccination campaign. Enabling factors of this successful vaccination campaign were strong national leadership, a well-coordinated national preparedness plan, and high acceptability of vaccine due to effective mass communication and social engagement led by religious figures, volunteers and local leaders. In this short report, we described the national strategic plan and enabling factors that led to the success of this historical vaccination campaign.

The second strategic plan of medical ethics: a national report

Medical ethics faces several challenges in different aspects of education, research, and treatment in medicine and healthcare practice. Design and implementation of a national strategic plan can pave the way for the development of a roadmap in various countries to strengthen ethics and address these challenges. To create a comprehensive plan compatible with the Iranian healthcare system, a multidisciplinary team of main stakeholders compiled a national strategic plan of medical ethics following several focus group discussion sessions and two workshops (2014-2017). Ultimately, the plan was confirmed by the Supreme Council for the Medical Ethics of the Ministry of Health and Medical Education. The current paper is a national report of the process and the medical ethics strategic plan in Iran. We have also tracked signs of progress and achievements in the country. In conclusion, this valuable effort has led to significant success in the implementation of medical ethics in clinical medicine, medical research, and education by using all the resources in our country. The participation of all the stakeholders, especially healthcare professionals in this way is required.

Cost of TB services in healthcare facilities in Kenya (No 3)

BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and within the National TB, Leprosy and Lung Disease Program (NTLD-P). We aimed to estimate the unit costs of TB services for budgeting by NTLD-P, and allocative efficiency analyses for future National Strategic Plan (NSP) costing.METHODS: We estimated costs of all TB interventions in a sample of 20 public and private health facilities from eight counties. We calculated national-level unit costs from a health provider´s perspective using bottom-up (BU) and top-down (TD) approaches for the financial year 2017–2018 using Microsoft Excel and STATA v16.RESULTS: The mean unit cost for passive case-finding (PCF) was respectively US$38 and US$60 using the BU and TD approaches. The unit BU and TD costs of a 6-month first-line treatment (FLT) course, including monitoring tests, was respectively US$135 and US$160, while those for adult drug-resistant TB (DR-TB) treatment was respectively US$3,230.28 and US$3,926.52 for the 9-month short regimen. Intervention costs highlighted variations between BU and TD approaches. Overall, TD costs were higher than BU, as these are able to capture more costs due to inefficiency (breaks/downtime/leave).CONCLUSION: The activity-based TB unit costs form a comprehensive cost database, and the costing process has built-in capacity within the NTLD-P and international TB research networks, which will inform future TB budgeting processes.

Population knowledge and awareness of antibiotic use and antimicrobial resistance: results from national household survey 2019 and changes from 2017

Background Lack of knowledge and awareness on antimicrobial resistance (AMR) can result in irrational use of antibiotics, which is one of the major drivers of AMR. One goal of the Thailand National Strategic Plan on AMR (2017-2021) is a 20% increase in public knowledge and awareness of antibiotic use and AMR by 2021. This study assesses antibiotic use, level of knowledge and awareness of antibiotic use and AMR and the factors associated with their knowledge and awareness in the Thai population in 2019. It compares findings with a similar national survey in 2017. Methods An AMR module was integrated into the Health and Welfare Survey, a biennial national household survey conducted by the National Statistical Office since 2017. The 2019 survey took place in March, through face-to-face interviews with 27,900 Thai adults aged 15 years or above who participated in the survey and compares 2019 findings with those from 2017. Results One month prior to the survey, 6.3% of population reported use of antibiotics (reduced from 7.9% to 2017), of which 98.1% received antibiotics through healthcare professionals and almost half (43.2%) for flu symptoms. During the last 12 months, 21.5% of Thai adults received information on the appropriate use of antibiotics and AMR (increased from 17.8% to 2017); mostly through health professionals (82.7%). On knowledge, 24.3% of adults gave correct answers to more than three out of six statements (three true and three false statements) (increased from 23.7% to 2017). The overall mean score of awareness of appropriate antibiotic use and AMR is 3.3 out of total score of 5. Conclusions Although progress was made on knowledge and awareness between 2017 and 2019, certain practices, such as use of antibiotics for flu symptoms and receiving information about antibiotic use and AMR, are inappropriate and inadequate. These findings require significant action, notably strengthening health professionals’ ability to prescribe and dispense antibiotics appropriately and effective communication with patients. The government should promote specific information on rational use of antibiotics and AMR to specific target groups.

On Neoliberal Exceptionalism in Spain: A State Plan to Prevent Radicalization

This article offers a critical review of the Spanish Plan Estratégico Nacional de Lucha Contra la Radicalización Violenta (National Strategic Plan to Fight Violent Radicalization or “PEN-LCRV”), focusing on its most controversial discursive elements. While it is not possible to perform a complete empirical examination of its impact after five years, we can highlight some if its achievements, effects and shortcomings. Through a review of the key concepts and logic underlying the PEN-LCRV, this article considers how the notion of security can enable the design and implementation of public policies, as well as the current trends regarding the relationship between social protection and punitive control.

Moving from Offline to Online: Addressing the Cancer Spectrum Through the National Strategic Plan on Cancer Prevention and Control, Sri Lank - 2020-2024

Introduction: Sri Lanka is committed to achieving the global targets at the end of 2025 by a 25% reduction in premature mortality from cancer by intervening from prevention, early detection, treatment palliative care, and surveillance. Current Sri Lankan evidence shows a gradual increase of cancers where many are preventable by risk factor reduction. According to the data of the National Cancer Registry, Sri Lanka in 2019, there were 14,845 (47%) males and 16,989 (53%) females diagnosed with cancer with a total of 31844. One of the recommendations of the imPACT review 2019 was to develop the NSP to achieve quality of life by preventing and control of cancer in Sri Lanka. National Cancer Control Programme, Ministry of Health, Sri Lanka gave the leadership to develop the National Strategic Plan (2020-2024) that provided a direction for the country for cancer prevention and control. Methods: Based on the local and international evidence initial draft was prepared by the NCCP. Feedback was obtained via emails and virtual meetings from all the stakeholders (medical professional colleges, UN organizations, non-government organizations, community-based organizations) due to COVID 19 physical meeting restrictions. This was followed by a series of virtual meetings with the same stakeholders and finalizing the document. Results: The NSP was developed for the year 2020-2024 as a guiding document for Sri Lanka’s response to cancer control and prevention with a vision and a goal to be achieved in cancer prevention and control in the country. This document has laid down seven strategic objectives and seven strategic directions to serve as pillars for the cancer spectrum with a detailed activity plan under each strategic direction. Conclusion and recommendations: The NSP was developed to reduce cancer incidence and mortality via evidence-based strategic objectives of prevention, early detection, diagnosis, treatment and palliation, surveillance, and research with an activity plan. It was recommended to have close monitoring, mid-term and end of five-year reviews to assess its progress.

Ageing people with intellectual disabilities and the association between frailty factors and social care: A Swedish national register study

The aim of this study was to describe the social care provided for different age groups of people with intellectual disability, 55 years or above, and to investigate the association between such care and frailty factors for those with diagnosed level of intellectual disabilities. Descriptive and logistic regression analyses were used. Commonest forms of social care among the 7936 people were Residential care, Daily activities and Contact person. Home help and Security alarm increased with age. The frailty factors significantly associated with increased social care were age, polypharmacy and severe levels of intellectual disabilities. Persons most likely to be in residential care were in the age group 65–79 with polypharmacy and severe disability. The results indicate a need for further research of how frailty factors are considered in social care and longstanding medication, especially then severe intellectual disability hinders communication. A national strategic plan for preventive interventions should be developed to ensure the best possible healthy ageing.

Technical Aspects of Web Photography as a Medium of Tourism Development

Information and communication technology is an important factor for national, regional and local sustainable tourism development according to the long-term Croatian national strategic plan. New forms of information, such as web sites; new media, materials, political and social change, all influence tourists’ decisions when choosing specific destinations. The aim of this research is to determine, based on the analysis of the tourism media campaign, the relationship between new communication trends and the application of photography as a medium that influences the experience when choosing a destination and the importance of crucial information factors on web pages based on their technical and visual characteristics.

Economic Sustainability in Wastewater Treatment Companies: A Regional Analysis for the Iberian Peninsula

An important part of environmental degradation is caused by the discharge of untreated or mistreated wastewater. The reuse of water is paramount to the National Strategic Plan for the Water Supply and Wastewater Sanitation Sector in Portugal and Spain. Since centralized treatment systems have proved to be inefficient, tackling environmental issues requires a regional approach. Wastewater treatment plants (WWTPs) mitigate environmental impacts and contribute to the financial savings of other firms. However, the literature evaluating WWTPs’ financial performance and economic sustainability is scarce. The implementation of a resource recovery technology depends heavily on economic viability. Thus, this paper analyses the financial sustainability of 222 WWTPs in the Iberian Peninsula by NUTS II regions in 2016–2019 to assess the region with the best performance and financial stability and provide regional policy implications. Using the SABI database, this research encompasses a numerical and narrative analysis of key financial ratios. Results show that firms in Algarve and La Rioja exhibit higher financial sustainability when compared to other regions. Results can foster enhancements in the governance of regulated utilities.